AS A FUNCTION OF THE INTERACTION BETWEEN

SINGLE-:JiRIAL TREATMENT .

~F

ANXIETY .

~

AS A FUNCTION OF THE INTERACTION BETWEEN

RELAxATION PROCEDURES ' ---A ND PERSONAL RESPONSE 1\1'bDES

I

BY'

((."

, C ,I

Donna Mar ieBculce,B.A.(Honours)

A thesishbmitte d totheSchool orGraduat e Stud ies in partial(ulrilmpntoftherequirementsrQrthedegree of

,I,.,Ma.ster orScience

.Department

o r

Psychology Mt"morialUniversity ofNewfoundland

April lg8~

. .

. .

st.John's N~roundland

-'

pe'pnission has been qr-e nt ed to the National Liocacy of c eneca"to---'mi'Ct"offlm this enests',a nd:to le nd or sell

cop,le~of the film. '

,The author (copy'rightOl(oer) . has re s e r v e e otho::.r .p u b l i c a t i o n ri g h t s, and neither the th-esis nor extensive exe eec es from te. may be printed 0.1:' oebervree reproduced without his/her

written permission.

L'eaticrt eetLo n"e~t~eccceoee

;i La ·Bibliot~que nat ionale du Ca nada ·d C' microfilmer

~:.~~~n.J~:s~e:texd:mp~~~~:~, ~.~

filfn'

L'auteur.(ti,.tu laire du;droit. d'auteur) .se raaeeve les autres droi,ts de pubLt cettonr n i la th~se: oi -ne longs ex e r etc s de ceLle-ci ne. .

~~;;:;etot ~;~~od ~~i: is:~~ s~~

autorisationl:!crl~~,

Q ISBN "-315- JlIiJ~IJ_6

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, .

: Abst.ract • ,r.

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" '- i,X·f;r " '; ;~,: :' r

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^{y examines'b.impcr snee01}ma"h in, indiv idu alresponsemodes aDd-'tre~tment^modesinrelieviD&:a"ulet':. Fifty-five.universitysl udl"ot:l' high4'0

,

traita'rix.iety Wl'le.('all'gori;r~as expressing.au iel y primarilyth,~ugbliOmntit

~ymptoms,

r,

cognitiveecaqems,orin amixed

' ..

fasbion. :Ib.lrth~subjec ts

,

in eaeh

'

"'gUup weregivensin!I~~tssion^{traininginmodified}proz:r~ive^museletl'lun.iio n.

"J. . ~. " •

•t.0d tb; etherha~rreceiv~dsingle-sessiontrainingin guidedimagery..I~rt"pullt. ", .sessionstat e anxietyand pulse-Tat emeasuresweretakenfo r aUsub]eet~.Otlwr

. '. . ' ^.

.post-sessi~D meas~res^includedsubjects; rat ingsortheirle~el,oraosorpt io.1Idur ing L.

"\•~be...:1i~n^{and theirperce ived}ex,pect ationsortre~tmenterrec:li;eMSS.TIII~^results. ,"didnot ind icate.a significant dirrere-RCebetweenmatched andun~at;hed^{group !',}

alt hough'allgroups.beca mesign~fic~n~lr.less anx iousL'I ~resu!t-.iL:raini~: '_. Becau se ot herstudiesb~Yefound makhibgof an'xiet)'modeand treat m ent

• . I '

fetbodtobeimportan~itisconj ecturedthat theabsence or• matCh ing,dre-ct.in t\isstudy w&.! the result,ofemploying'onl)' a single session, oror the characterist icsofthesubjed sample,orpossiblyoroverlap ping etreetsbet ween

I '

relaxat ion :netbods. Furtherresea rcb'd irectionstoc1ariry,theseeseee,wNe discussed. f •

I _{I \}

r I

1 ,'"

) c ; _.'

-' -' . I iii

"

I wish

to:

^express

m r

g'incereappr eciati on to several_J;l~p'e-~~.h?made

..-. ' .

..

^{, ". "}","'..~-~..'

.poss,ibletheeO~'pletionof thistbes\ Iamindebtedto mysupervisor,

Dr -

Cha rles

Presto n, rorllll s untir ing direction ,encour agement and entbusiasrn.His invaluab le'

.

.

.

guida[l ce will always be rem embered'Bod appreeisted'.To my'.ec mmit tee 'members;

D~.

^{David Hu.tand}

D~.·

Michael Stones;

- J

^amgrateful

ro~

^their

suggestionsand theirunqualifiedwillingness to answer mynumerousquestion s.. for-!;tati~ticai~elp"thanksareextende dto

Dr.

JackStrawp ridge,Dr. Graliam

.Skanes,Dr.Chu-lc Lee,and Mrs. Cat hy Lee,'and tor.their time and answers,

thank youtaDr.AlbertKozmaand Dr.MichaelS~errick.JamrurUi.~rg;.atefulto theDenn orGra duateStudies for·l'inil.O"cialsup porttbro ugbouttbe program..I"also -.-.- --.---wisb--to-ackn.o.wled.ge--D~.-·Pau--I----L-ebrer---and-Iff;---Gll.ry--Scbwartz·-ror-permission-to-.--,­

usetbeifquesti

.

onnaires. Special recogniti on and^{~ "} than ksgo tomybrotber-Steve--- '-'- -~

...

and'his fa,mily,tor_!raphi~work and continuedsupportandassistanceth roughout the project. Andfinally,tomany Iellow Psychologystudents, torguidanceand patiencewith my'tnnumee abletechnical questions-yo ur tremendoushelpdidnot go unnoticed.

.. ..iii ....vi

. : vi1

',' .

Tabl; ofCon te nts

...-A

Acknowledgem. nt.'":"

~istofTabl u... .\. ~ist.^ofF~S:U:es^..

- COllc.pt\ial·Backg~.

'I llte: act!enal.~ppro&e~..

Theco~c ep t.,of....an::d..ty

L&ng'.Thrlt -Sy .t!m.Yodel'of aDXhty. ,.

Pag•.

.." .:11

\

,I

.,..1

· ·" i) '

....j/'

"

Sl11III;&ty .-,

~

.

Ru earc h Backgr ound..

... . ... .... . . .... .. ....7 .... ..7

. 8

IndiTidu.l ru pon.. pattltn. 1nallxi ~t1n ••.•rch~ ...,9 Th. preeu. of r.laxat io n..

Rdasilt ion proc ' du; ". ...

Studiescompa.ri ng rela,zationprocedurea..

Appro.ch ud hyPothe si' Yl t bod .

SUbj ect..,:.,

QueaUonll&i:u.114 APparatu., ,. , .Procedure,.

.. .. . .!13

.... .16

,17 _~'

•....24 . .'.32

... .32 :33 ..36

•

^/ _TableorCo~tent8 (~ont.)

Page

·R "ul~.

Subje ctSelect-iOll..

. 38

. ..38

I!r.-tnatlll~lItAUliflllllnt.. . ..^,~.... ^{. ...40.}

TreatlllintAutullln.t..

·s tAI (; , -0.

Pulu rate..

....

^:

..

..4 0

. :4 0

... ...41

"

,..'

Probe qUlhiollulrel.

POl t - RelaJ:at.i oD SI.1l1011Qu . e tio lln a i r t Di.c:u••lon~".

RefereDC . ...

Appl ud b: B APP'Q.d1:l: C.••

APP.J~i:r:

^D...

~

^....

, ,j:.'d~'

^E,':.•-:.

.Appendix'F.

Appindi:l G.

Applndl:1H-:-~ - App.ndiJ:

.

t.. ...

Appurdilr:J.. •.. ..

...

.41'

..61 ....69 ..83 ...84

...65 67 ..6 8

... .,..69 ... ..71 ..78 ,..,~8 0 .•.B3

(

'I. ::J . ,.:.. . . •

... . ⁾ . . '

Listof Tables

Tabl . 1:

tM'~'

^{!.c or . .}

~h

^{thesTAt (Trait);&!leitheCSAQ}

fOfall group... ...34

Tab l e 2:'-M' AD Icore e'onthecogalt-in-Somati cA.DxhtJ

Quutlonnain P.::. . ... ...39

. 48

. .

Table 3: M.anrupoll'"to probl qn.' t l'Oufor ....!!1_~1!.ct. 1~tachcondition...".

. • - .... . \ I

Tabl._4: ¥1a.n·ra t iDg lfor proll••q~..tioll .1andPOlt"":

Rel&X~tlonShl1o~QuUt10nlli i nit ••e(1-1 2)... •.60 Table 1- 1:ANOYAIWIIllIar y'of meantrait'~ltllt1 fo~^thethree

anll:~.t1 g~oup•.priorto'r'l~..tion tralni ll.g 80

. .,

Tabh't-2:

~

.u.lllmary of m.all .tat.

~S1etJ f~r

^{thethr .}

anxiety group.prio r to relaxati ontraining 80 TabllI-~:ANOVAIUlIIlPfyof mun pul. . rat. forth. thr. .

&JlxhtJ group.priorto relaxatioDtraining 81 Table 1-4:ANOVA nmmary of flleaD .tate e::liety for tb tbree

~xh t1 gr~up.bdor.~ndaf,t lr'rel ax ati on" ,,81 Table I-S:ANOYA.uIIIma r y oflIl.upul ..J::&tI '.tor tb. tbr. .

anxietygro~p.bdoreanda rer relu:atioll." , ,, 8:, __TableJ-1:,Pair.•d.~~ompar1l011.'of !DeaDil0UPr •.IIPonento

the coglrt'ti,.'{eanxiety ltllllion tb CSAQ.".... ,.. ..83

)

Table J-2:Pair.d compf'"1I0n.otIIlIlUi~ouPr . .poUl" to thelIo~tlcit.lll11,ontheC~iQ .,.,;, . ,.. .-....", ..83

)

e ,

I

Lillt of Ftgu ree

Page. Flgun 1:Pre-polt tra1nl~g

.'.BiOD

.tat'-an:r.l.tJ

1ll.1JI.

for the thr tt &Il:r.1ttJ groupl. , ,,42 Figun2:,Pre - po . t training " .. lon .t.te-u:r.1etJ

Ill.U'

for the two reluatlonmethodll.;..,. ,.. .,. " ,43 Fi gur ,.3; Pre- polttrainiDg ...Bion .tat.-u:r.htJ JOu.. for

~ &ll:rift1group~'within nch J:Uuation D.thol!:.,.. .',4(

Figure4: Pn-po.t tralniDg .... lon pll1. .-rate

i'

~

. Ill_In.

for tb three and.trg~Ol1P'. ... , -:45 Flg~nS:Pre-'po.ttraiDing .... lon pul_.i-rat.

m.aDli for the two relu:ation method.. . . ..".",,45 .Figure 8:Pre-po.t,tralniDg.... 1011. pul. .-ratemlaD"for

all.:lhtJ group. withineach reluationmethod .. .. ,.41 vii

)

,

I _\ ^{. /} / ^.

•

e A.nxietyisanimportantnodcentralecneept inrl!l'it'alp~~· ('holll()'.TIll' interactionalapproa challows

d u e

weigbtl~beginnto the{'ompll'xili~

o r

tho interac tionamongtreatment variables'and indivlduald illcrences inthe{'xpn' ssillli andexperie nceof anxiety.Moreprecisely,theinter actionalnppro neh providesn research strategyfor'evaluatingthe importance,ormatrhingpersonal.,nnxi,.t}, tesponae modeawithappropriate-anxiety treatm ent.

Inthisthesis.'t he interac tionalapproachis appliedto anxirlytreatmentby

"assessing the effectiveness or.tw~ relaxati on m~thOfb, p'ogr('s.~jv(' ^musr-le relaxationand guidedimagery"in the reduction of the somaticandrngn it ivl\

. "

components ofBnxiet ,.Itis predict ed,tbatgr~3tcrtlrerapeufic benefit willtl'~llit whene'subiect's

inxiet~·~ponse

^{mode ismatched}to a relaxationmethod which

. , ~ \,

--

focusesonthatsame..

~'{

This pred iction emerges tram aconsiderati on orbeth I

thetheoretic aland the researchlit erature.Thetheoreticalliteraturewill he ral~eworkthat_d('lll~adequa tely

Following the development otthe eceeeptual .rrame"Jork.rel{'vant r{'!letmll literature'willbeexaminedinregard toindividu alrcspon~-pnt[f.i'n.~in anx,i,.ty expression,theprocessor relaxation , andrela"atio~pTOcmlllre~tiltlth:l.Vl·1l,.1'h appliedtothe treatmentoranxiety.

Coneept ualBaeJcgroun~

. .

. 'InterlU'tion alaporoach.In recent yean , it _ha.~ become apparent 1hl1t

attemp~

^toatt rib ut e the varian cein human behaviorto

pers~Mlity

va riah!l'!>

/ ---. - ) .

wit houtrCll"udforsit ua.tiona l

Vari~~\Or

to situationa lvariableswit houtregard lor personalityvariables reflect aninadequ~tetheoretical bas eIcr either resear ch or clinical application.Thisdot'S not implyHtha~persons or sit ueficns are unimpor ta n tsourcesof behavior al varia nce:however,in many clinical"and theoret ic"al cases,it hasbeenfou nd,th at(b e proport ionofvarianceattributableto .the interac tion betweenthese variablesoutweighstheproportionattributab leto (lil hl"Tvariablealone Bowers(lg73 )argues -tha t both the'trait a~d ^the llitll~io!!..alpositio nsarelnaeeur ate and misleadin g and that aposit ion'stressing the-interact ionofthe perso nand the 'lluatlr-nis both conceptuallysatidy ingand

.mpi';,~1f;).,,"n,.d ·

^(p.125).

Anin tera.ctio~istorbiocognitive view.denies the priorityofeithertr~itsor situat ionsin the determ inatio no.rbehav ior; instead,itfullyre~ognizes tbalany main t'rreet!t wlfich-do emergewilldepend primari lyupontheepart icnl arsampleof sett ings andindiv id~ a,ls.In other words. interactionismargues~hat ·sit~ations';l.re asmuch afuncti on oft~eperecnas the person'sbehavioris afunction oftbe sit ualioll'" (Bowers,ID73,p.152 ).

.As Endler (1975) observes,the concept ofinte ract ion is'notnew.The se;tntcent hCl'~tu~y^physicistRoberl Hookeproposed Hook e'sLaww~ieh1stal~S

,

. ~

..

that'wit~'l~the elasticlimit,st ra inispropo rtiona l to stress. Forfluidsandgases, elastidl})n

a~dirre~ent

^meaning " (BridgW&te; and Kurtz,

1~63,

p. 637)"State d'· dirrerl'nt1y,~theellL!i ti l."ityotasubstance

. _-

is an in te ractio n between the

.-

natureot

.the material and thedegr ee ofsit uatio na lstress.B~extens ion,Hooke'sLaw may \

be apPlied to theconceptof anxietyin that.an xiet yreactions areaninte rac tive "- ..._ Innetio nofperson alitytra its (the"natu re of.the material) onthe onehand,endot

Uodges,.I068).

Endler'00751 summa rizessomeof the data based on't~e vari:hu'l'"

partiti.oni,ogmeth odology thatdeal...ith the'SitU~~io~.,versus person('ontrovl"r~y""

EndlerandH~nt(l060)forexample;have presented self-reporta~ xi('t;dat a based ontbeirS-R"Invebtcnes ofAnxiousness{Endlereral..'lg62;Enfllrrand' Hu?t,.1069)'for22-sa;ples of

mal~/nd'

²¹

sam'pl~

^or-remat

subjecls~ \h.(>~

,foundthat ontheaverage,individu! 1dirrerencesaccou~te~

itr

4.4-1 percentorthe

, ' ,

•variancer~r,males and4'.

56

percent-ofth~.varianceforfeJl)ales.,while sitid tiol)nl.1.1~.

\ "

/:;,'

..

Co :!,vaj..ianc~a~~unt~~(or 3.~5percent of.thevarian~e.r~r ~a!esand7.7Sr.jrte ntn.r .

"

tbe-~~ce 'fo/f~al:;,

^However,

ea.~h

^orthetwo-way'interact ions(P ersOnsby.

\ , -_ .", ' , , ''XS<-

'Situations,PersonsbyModesofR!,!spon.se~andSituationsby_M~esofResponse] ,

,accoun'ted foraboutlO percent ofthe'V~;'iance,

, eo

Furt hermore,Bowers(1973)prese~ts ' asummlfryorII st udies,'inrlu~ing dat~.,baSed" self-.repormeasures of anxiousnessan~hdslili.ty,~elf.rl1tin~,..f)' r~elings' ortrust,affiliation,arfect,etc" andactu~1orobservcd'beh~viortrlat ed to honesty, smoking, talking,etc.'Hefo~nd th~ttheperson~tl()njntem crion ..accountedIor morevaria nce than eit herthepersonor_the ,situati9~^in14outor' IS possiblecomparisons.Spectfleglly,Bowers(1013)rc uc d thatfor,Uiesestudies,

~'-"-:the

, ^{evets ge}variance dueto persons was12.7·1 percent,

tha~('

^due

. to'~itU:lioM

^wa."'

10.17percent, and theverlenee due-to person bysituati~ninteractionwll.'120 .77 percent,Asall'of these studies

indicat:,lint~rnctions '

accounted for^'3great er portion ortirevariance thaneither

_, ~erson

^orsituationC

_,

^iables.

_I alo~e. _{' :}

^Itshould

_"

be ~otcd however, that more'recently, researchers ~ave.apillied sevelll!.

I :

~'

'.. J.

,,'

( "

tl1rcthodolog~ovation5to,thesludY'0r personality(see,lor example, areview.

... f.

~'I#' R~d

^{Widiger,1983). -}

~

': Neverthe less,Mischel

(1~7jl lluggesls

^tbatit is insufficie nt

~knOWledge

theeXis~('n~eofinte racti ons,ODe.sbou~d^alsobeayleto pre d ict the nat ureofthe intc rae ti0 r.:'inorderfor thescienceofpe~soDality.tbadvanc e.Endler(1975)

".describ es .

such

^a

ptedictive~ m~del,

^aperson-situ ati oninteraction almodelfor

anxiety ,in which anxietyastper sonali tytrai t is viewedashaving three'racto rs:

. .. . Ir "

interperson al enxlety.,physicaldang er anxiety ,and am biguous 8oxietr.The mukidi rnensionalnat ureofthismea;sureenables one toexaminethe int,era:ction

ht't~r(>n'^{thetraitaspectsofanxie tynndsituationl,ll'stressin,}~roducing^artual.

s' : trs" of.anxicty, tlowever,Endler points out that inorder for'tbis

p~n

^'by

situa tio ninteraction to be effectivein inducing stateanxiety, itis necessaryfor 1hl1 traitmeasure to be congrue nt tothethrea h!ning situatio n,Forexamp le, it

•

."

^'

'"

canb~,predictedthatthetrait of interper son alanxiet ywillin tera~t_~ithan' in ~t'rpl'rsonal I~n'atsituationto elicit anactualstate ofanxietyalt hough itwill notinter actwitha physicalthrea tsituatio n.

•

~n

^{:umma ry,EndlerP075)}

e~PI~i ns ~hat

^views

reg~rding

^{trait s}

~

^the-prime

dete rmina n tsof behavi or'haveled to muchmisguidedresea rch.whileanapproach whichfocusttl exeluelvelyonsitua tio na lfactorscanalsobe misleading.Hefurther

,I, -. \ ~

.rl'mnrks l~afdue tothe'compll'xity ofhumanbeh avior , psychologistsmust be wilting

' t , t~ lol~ra;e -

^{ambi guityand}

c;~mplex

^~approach esrath er tha n lu'rning

t~

simplesolu~i?nsJ.n^{terMS ofeit her\ra i19or}situations,Aspecificconsider atio nof

.. ' ' -.--"'" I

inler~CI!unS_wo~JQimpro~person alitydescr iption

'-6y

emphas izin g~hl1tkinds~t

~^responsesindividualsIT\1lke\wi thwhetintensity invarious kinds ofsitua tio ns-

Thl't"'onr l"ptof anxil"l\'.~13jorinterest in 1111' prt'l't'nlrvseurchlil'~inHII' interac tion bet wee nindivid~J:l1anXll'l)·response modesIpl'r~nl1:'1ht ~·\";Hi ;l h~l:lIlll alternativetrratm l'Atprocedures(situ ati on alHlria bl('sj,,-\nxil'lyi~awill\·~IH\'all

p~en'Om('nonwhichJIM'receivedeons fderableattention inh4 thIIII'rl's\'arehand

, -

clin ica l literatur e.Anxiety hasbeensho wn tohavemajor t'ffrt'\sonsuc h diverse processesas perceptualabi.1ities; performance'prurit-it'nry, !I'arnillj!;, nWlIllirYr fogniti?n,a?dsexualr: sponsi vity.Ni.t'tzelandHornsteinl1U~1)nou- thatt"'l 'r)' major(lheory~rpersonality

.

and.psyehop;at hology

^-

hasemphasizednnxit·tya...a necessaryexplanatoryeoncept.c

Anxiety,however,-isahighlycomplex~YPOllH'tiraleonstruet.Ps)' rhu lo g isb 'han ' studiedslate and trait a!!Xiely,conditioned or rt' al· ti~t~nnxiery,nnd cognitive.behaviora l,or physiologiealanxirlyresponse components.Furthermore, anxiet yclearlyinvolvesboth personalityand.sitll:ltin.n:l1 vneiablvsa...prt'vi"usly not edinEudlet;s(107.')) summaryotsclr·rrporl anxiety data.1\.lurr<'lV('r,:i.wide variety of'assessment devices has beenem ployed10m\'n.~.•~~l·nnxiety,such as psy chophysiologicalmeasures.behavioral rnvaeures.nndSt'lr.rt'p~rt mensures (Nidzeland Bernstein,LQSl j.And finally,several1~'Pt'sof treatments,fmtll . psychologicaland pharma cological,areavailable todeal ~itll nnxi(·ty.xlnec Lang's(106S) Threc-Systrm sModeloranxietyprcvl.lcssomeorthe rat ionnl/) lor thepresentstudy,itwillbedescribedbrieny.

Lang'sThrN.,-Systl'ffiS Modeloranxiety,A~rllrd ing10!.1I1l1t(IQGHI.while the experienceof-"(('atinvitesustoperceiveit Il9 n unitary r.-d inK:lnt!thllsn.

eorrelutedsetofsimilarly determinedresponses,the measurementoffearbehavior leadsto anoppositeresult.Tbat is,anxiet y i3not a unit arysystem.Rather,it is composed of three somewhat independ ent dimensions lcognitive/ subjedi ve, physiological, and behavioral), Thus, differen t measur es producedifferent e.fmatesoffearintensity and furth ermore,different variOl-blesappearto control dirrNent aspectsof,thefearresponse.He notes,Torexample,thatlargeindiv idual

.

. .

(fiUerencesarefrequently observed in subjects'responseto desenstueeucn.Some .

sh~w

^{gninsinove,rtbehav ior,and,others}

m4

^{r; port}

I~ss

^{Iearorappearmore}

relaxed,withoutanychange inapproachbehavior ,'

Insummary, I.-nng(1968) observes that mosttherapi es aregenerallyaimed at II.br.~adconstruct called fear Or _an~iety, However, one_mu~tapproach treatment withadifferentstrategygiventhatthe responsesused to assessthe nnxicty constructshowverylittleunity.Thisul~mat elysuggests,therefore,that thNllpy shouldbeII.multidimensionalproc~in which-specifictechniquesare rrili<'nllyandsystematically-selected andappropriat ely applied to the-different behavioralsystems we areattemptingtochange.wheth erv('rbnl,overtmotor , somatic,affective,orcognitive.

. • ,I

Hence,in theclinic,theglobalanxietycomplexmustbe analyzedin terms of itscomponents.Forexample,aclient'spresentingcomplaintsmayinvolve_ r1l'orlydefinedsymptomsinoneor moreof the threeanxiet y

...

responsecha nnels (eognitiv'e, behev lorcl.andphysiological).Such a dcej-nchr ouy ofanxietycha nnels wouldtherefor e requirebeth multi-methodassessmen t II!nd multi-component

-,

treatm ents thft give,due weight both tothe indivlduel'sscharacteriarics and envlronmentalvariablespresentinthesituation athand,

(

AnxietyllndJ{'laxa tio n.Inrecentyea rs, the high pre valen ceof!l"xit>lyh:L~

encoura gedpsychologistsamongotbcrs-todev iseIInlril'ly

or

pro('('lh lfrsfur noxiety ma nag e ment. AssU~:lriZcd^byCO;mil."f:load ('nrm i"J(iflolll, u·!nx atiHIl training. is all:.of~~5-Jromisitlgtechnique sfortrt' :\linjl;:lnlCil'l y,and tlllll'r cli nicalproblems.Origi na llyintroduced byJacobson(If}:!n) as aprurl·lhlrt·('alll'll

"progressivef£>la.x:l.tion,· musclerelaxa t ionW3.'1InI('Jdeserjbedby~Il('(I{l.'il'll asan'3.lixiety-inhi'biting procedurewithinhissystl' n;alicdt'Sl'llsitizn!inllst r:atpr;y.

.O.t~eJs,such,asBernst~inand:Borkovee(lt173JandGoldrrit'd.nndDavis.. n(lfl7tl) hav e alsowri.t,ten extensivelyon relaxationtraining.CormierandCnrmi{'f(HI7flJ citesevera lstud lesi n whichr('la~ ationtraininghas b('('11employedflltr1ir lltswith insom nia,"hlgh blood pressure, epilepticseizures, asthma. ten sion hl'31Iarlll's.

,

painful labour, and ofce uree.asananxiety-red uct ion proced ure. .

.r.;;;:: - .

Otheraut ho rshe vedi~1l"SS1!l aUlo ge' .!!l1inillg,Inadditio n.mqre:recent approachesusing clients 'Imaginalca citieshavecoincided wit h the current

• I /

deve lop me nt ofvario.us cog'hitiY.e.lrehavioral thr rap irs (s{'('IaIl'rJ,

Sum mar y,Inview ofthe complex itiesof theinternctionn!npprnaeh, tho

"

.anxietysyndrome,an1 anxiety management proc edures.Itisobviou slyIm portanr, both/Cl ihicallY \'nd_{I •} {hcoret,ira lly ,to ide ntify the

~ntillb l('s

^{illPI1('horthest',ateM}

,.tplevant topredteungtheoutc o meof lbet :l.py . A grentorunderstandin gofthe reblio,;ship between client cha raeteeis tics and thernpeutie va riablr !l should increase the<,Weacyorthebehaviorchange processandmorepeo plemig ht therefo re remain in therapy andshowst ronger thernpeu rie geine [Norton ,

Oinlvdo,andHarlow.·IQ83).Byanalogywithpharmacologicalprescnpuon .not everydrugcompound is,equallyerfective withevery patient;relevantindication must be carefullyconsidered.

Resea rch Background

In psychology also, concern'with tailoring'treatments to the uniq ue .ch.a~ac:erist ics. olindividuals.isnotDew.Almoettw,odecad esago,Pau1jH)60j-

posedthe important question...,·.Whattreatment, 'by whom, ismoreertecuve roe t.hisindi.vid,~1ll~~ththa)specilic problem,under which set orcircum~tances,.and

how.doesil,._~orti.eabout!-[p.44).Behav ioralresearchon clinical'_pho~iasbas

. .

^.

grhera llylumped together patients with thesame diagnosis,and r~ndomly' ,assignedthemto treatmentsto addresstheoret ical orproced uralquestions.As ' \

Borkovec(1016)stated, thisresearch"almostcompletelyil¥loredtherole01 individual..differencesin anxiety-response components,despite Paul's(1069) warning that theq~estioDoftechniqueellec~veDesscannot hedivorced(romthe subject charact eristic'con; iderat ions- (p. 274). Funberrncre, according to

~.' 1

^Mathewsetal.

'rwsn. -u

w·ouldclearlyhe orSC!me'practical and theoreticalvalue

to predictwhowould'hen~rit^mostIroma particularmethod..Unfortunately,to date ,lew usefulpredictorshave-been(ound" (p. 142-143).

Since Paul',(1060)question ,jeseereberehave attempted. todeterm inewhich dir nt characteristics could acta.s usefulpr~dictors^{oftherapyoutcome.'For} example.in an experimenttoIllustra tetbe importanceofobservinginteracti ons betweenintroversion/extroversionand hypn?tl zability,Preston(1082) roundthat

extroverts weremore hypnoti zabl e in a groupsituatio n,whiletilt'(\PP(J~ill'W:L~

true Cor introve rts .Thissuggeststha ttheclinicia nmustberl'''p'()'n~ivl'¹⁰the('11(':<

provided by the clien t and then app ropriat elytailorvarious aspoetsorthe treatm ent;inthiscase, theeovironme,nta lccnung encics.

j

^{In the}a~eaofPh~bias,a~danxiety.~evet.alst udieshovealtt'mp ll'lltoi~ol:,lt"· andmatchclientcharacterist icsto.specifictreat mcD\procedu res.Lnn.~·s(W OS) Three-Sys~emsModelofanxiety, fot exam ple,buprovided researchers with .one userul'rot~or 'individ ual~istinction.·Resear chers;' sueaes Rac hmanIlg7~).Ii.a.ve alsoargued thattherearedistinct patt erns orexperie ncinganxlctyandth~tth"St' might bedirret eilti allyresponsive todiffer ent. types or",treatment proced ures.

Norto ne~al.(UJ8Jjreview someorthe anxietyresea~chwhich has considered the matchin gofsperificpatte rnsoranxiet y to tr ea tment (Borkovec,197.1;Ship ley, Butt , Horwitz, and Farby,\978;o«.Jerremalm, and'Johansson,HISI ;o«, Johansson, and Jerrema lm, 1982;Sha ha r and Merbau rn, 1081;Norto nand Johnsoo, 1983).

Indi vidu alresp onsepatt ern sin anxiety resear ch..Bcekovee (IQ73~'wtLt inter est ed intheinteractionbetween exter nal cues(suggestionor impro vement) and intern alresponses. Hecharact erizedsna kephobicsinto fourgWllpS(str ong ..versusweakpulserat ereacti vity'and st ron g versus weak per ceivedreact ivity based on their heart rateresponse when exposed to a snake,andon thelr responses to the'Man dler, Mandler,and Uvillcr (lOSS) autonomic'percept' on questio nna ire .Followingi~itialassessment, thegroup sreceivedinformation and instru ctionsCorinte~acti ngwithsnakesprio r to being ret ested on theirabilty to

,

\

!O

approachthesnake.Aspredict ed.repeatedtesti ngand intervening instr uct ion s of

-~

improvem enthada great er effect on tearful subjectsdisplaying weakinteual responsesthan00 fearful subjectsdi!play iogsho. internal :esponses.It was suggeste d thatsubjects whowerehighl yrea ctive,physiologicalresponders didDot improvell.Smuchaslow physiological responders to ac?gDitiv~type

o r

t~eatment procedur e.Further more,itwas Dotedthat itmaybeworth while toview therOUt subjectgroups asspecialanalogues todiUet eol·clinicalgroups,andt~^draw implicatio nsfOTdifferent ialtrc~tment.

In the study by Shipleyelat (1078), egroupofpetlenuwes exposedto a videota peof aJrcssrul~edi~a.1procedur e ofendoscopypriortoreceivingupper- gastroin testinalendoscopy.Theresearch erswereinterestedin the intera ction .bet weensubjec t'charact eristics(repressors versus sensitizers) and numberrot

exposu r~tothetape (0,I,or -3).Subjec ts were dividedintogrou ps'usingthe Modified Reprcsston-Sensttfie nonScale developed by Epstei nand Fenz(1067).

. r ,,-.

Repressors arecharacter!ze~as avoiding anxiety informat ion while sensitizers generally seek informat iontored uceanxiety.Regarding thei~terae~ionbetween subjectehereet en srles and prepar ati onmessage, ofthese subjec ts whodid not view thevideotap~,.thosewith a sensitiz ercognitiv e copingstyle hadgreater tnereesesin-h.eartrateduringtheectua!endoscop~than thosewith repr essor coping.!ty le. Sensitizerswho wereex.posed to oneviewing, however,had smaller heartrat eincre ases and were eva luated as less anxious than repressorsbavfng one riewing_No difference-existed betweenrepressorsandsensitizers who viewed the videotap ethree tim~.

lrbis

was explain edioIig~t^ofthe hypoth esisthat repressorsmaintainlowarousnlin theface ofthreat by avoidiogIet crmettcn

\I

seekingandthoughts.ThusODeexposure to the tape weakened thl'irrI'prt>Ssing defencesand left them in anarousedstatesi~i1artouDpr~parl'dsensuize rs.Thes e resul~s suggest that repressor~ and sen~iliz('rs might benefit fromdiUl;TI'nl prepa rationstrategies.

Nortonet at (lUS3)eeuu c o, however,that thelatl ertwostudiesprtlvidt' • only tent ative sup portforthe us of pretr eatmentmeasures ofcomponentsof I\nxiety forpre~idingtherapy out me.Inthesecases,only one dimension of 'anxietywas measured:and onlyonet e oftreat mentwasused.Reet'ntstudies

haveprovided more directevidence.

,Ost andcolleagues (HISl ,tgS2).conductedtworatherslmilnrstudieswhich

demonstr~tedthe efleetivenessof matchingtre~tments^tothe responsepaltt'rri!lof phobicpatients.In[be tir.st st udy (Ostetal. 1981).psy~ hiatticout pat ientswit h social phobiawere assessedusinga video tapedsocial interactiontest . Ontill' basis ortheir reactiontothetape situa tio n,patientswere divided intobehavioral or physiologicalreactors.HaU th.esubjectsineachgroup wererandomly assignell to either social,skills trainin g(a beh aviorally-focused.mcihod] or nppliod relaxati on(a physiologically-roeusedmethod).ThehypothesisW/l.SsupportedIIy 'thedat a to alar ge extenf thatis,irr". vcctiveof responsepattern ,thegroup treat ed-withamet~odthatmat ched.itsresponsepatternaChiev:d betterresult s thanthe grouptreate dwith theinappr opriat emethod. Amongbehnvinr al reactors,socialskillstrainingwas significantly betterthan appliedrelaxntionin six of the(enmeasures, and forthepby:ioJogicalreactors, applied relaxat jonWM significantlybett er than~odalskillstrain ing onthreeof themeasures.

In tbelr:subsequentstudy,Ost et al: (1082) assessed claust rophob ic

,

12

outpat ients in

a

^smalllest chamberand dividedthem intogroupsor behavioral

andpbY8i~ogicalreactors,Withineach group,patientswere assigned tooneof ~J:'II:"

exposure(a bebevioeelly-Ioeused method),appliedrelaxation(a physiologically- focusedmethodl ,:ora waiting-listcontrol. Altbough

,e

tw~.acti vetreatments both yielded a largerreductioninphobicbehaviorthan thewaiting-list con t rol;

nevertheless, irrespectiveorresponsepatt ern,thegroupsrecei~ing^treatment method,matched~o^theirresponse pattern (e.g.physiologicalre~ctors^{to applied} relaxation)achieved.better resultsthantheunmatchedgroups.All' clients that receivedthe

ap~r~priat-e~ire~eDt

^{wereconsideredclinically}

i~proved,

^{'compa red "}

lo 50 percentor theclientsreceiving -theunmatchedtreatment. The resear chers summa rized theseresultsbyconcluding thatit does seem important'carefully to

. . .

conside r individualdifferencesin responsepatternswhen planningtreatmentat I"", Ior

d""~(rophohi'

^{patients. \}

Shaharand Merbaum (IQS1) persuedBorkovec's(1913)suggest ion tha.t physiologicalreactivityan~.autonomicpercepti onareseparate dimeusicnswhich inc6mbination migbt predictaneffective responseto difrerent anxietyreduct ion procedure s.Subjects with interpersonalanxiety werecharacterizedas strong react orsandst rong perceivers(S~)or weak reactorsandstrong perceivers(WS).

Physiological react ivitywas assessedby thedifferenceina,i'5..second pulserate

i f

^measurebefore and eneehearing a tape-recorded description'or astressful situation.Autonomicperception was determinedby a modifiedversionor the Mandle r,Mandler, and Uviiler (1958) autonomic perception questionn aire, Subjet:ts were'tandomlrassignedto

~ither

^Syatemetlc

Ral\o~al R~tructu ring

^fa

primarily cognitive method), Sell-Control Desensitization {a' primarily

) , I.'

physiological met hod),orawaiting-li st cont rol. The hypot hl'llisWl\Spartially supportedonsome measures. 55 subjects achievedbettertherapeuticgains wit h desensitization, while WS sub jectsjmprov~~morewithration alrestru ct ur ing.

~Norto net11.1.IHI831point out,thissuggests thai a person 'srceponsero treat ment mayberelated not onlyto the person's absolute level

o r

respon din g in each oftbe three dimensions, but alsotothe person's awar('n('s~or. ^that dimension .A!l.they sugges t, people's self-eval uat ionof theirrxpcril'nreof [ear predictst~eirresponsesto variousanx~ety.red ucingprocedures.Furtherm ore, sincenil peoplewho

experi~nce

^fear

wiii

notbenefitfrom thesame trontment

.

\

.:

program, animpo rta nt'considerat ion fordesigningtreatmen tprogram!is an,

. i . '

assessment'of theindividu el'apretr eetmen t patte rnof cognitive, phy.'liol1>gieal, andbehavioralmeasuresin relation to(ear sti muli,

In addition,an import ant consideratio n fortreatmentis an analysisof thf>

compOD en ~,within thetreatm entprocedur es. One widelyusedtreatm ent (or anxiety isrelaxation, Despite thefrequently observed findingsindicating that differentialetreetsare'elicitedby different forms ofrelaxation(Paul"l(i6U), investigatorshave gener ally treat edrelaxa tionmethodsas irtheywere equally effectiv e with allclients, Furthermc re.tjnv estigat cr a havegenerallyeeeept ed the phenomenonof relaxati on withoutexamining.its,compo nent precesses; The following sections willfurther addressthesubjeAorrelaxat ion.

,

The process of relaxa tion,In theirreview of,t hepsychobiologyofrelaxnt,inn andrelatedstates, Davidson andSchwartz (1076) propose theexistenceorseveral elementsin therelexeucn process:cognitive,somatic,and aue nuenalltld ive

14

versu spassi~e). Thepeeseetstudy·addr~~in particularthedistiottionbetween c0ll:0itiveandsomaticcomponentsorthe·.anxietyexperienceandofrel axation

tl'b.ution.Davidson and&hw~tlz

1 _

^{'notethatsome oftbemost}provocative ft'Surt h on(f'b.xacloDbasemergedborn theslstemalkd~D5iti2atioDliten. tuff'.

Initsoriginal conception [wolpe,IOS8h systematicdeseDsitizationemployed progressiverelaxation(Jacobson.1038)asaresponseantagonistietointernall~­

ge~era.ted

'anxiet y -prOvoking

stim~li.

^{Themainprocesslnvolvedinthistechnique,}

reelprcealinhib it ion.(W~lpe,..10S8)involved superimposingrelaxationonthe ll.Dxil'!ty -reac tion. Given Jacobson's(1038) con eluelcn tbat the gene rat ionof thoughtsand feelingsisimpossible when- thebody""partsinvolved are telex ed, one -.might ques.tion iritis possibletobe som atically relaxedaD~eogaitively~nxious

~imllitaneously. Davison(i 0661citesnumerous st udies(e.g.SolomonandTurner, 1062;Smith et al., 1041)from wbich thefollo wing inestafa bl e conclusion-is drawe: Asta t e ofcomplete-muscular relaxat ion [deflned

as

the absence or a.etivltyat the most periphe rallevel) is not incompat ib lewith .cognitive anxiety.

V.

As

o ne

^eheatexp;~ed^it,

· M ,

^bod,isallrelaxed~^but

m r

^mindisinaknot·.. • [n 1068,.Raehmanoffered a theoretical

·ooncep~D

^or

re~axation'

^\;

dirrerentbting muscul ar relaxat ion Ircm "me ntal· relaxati on. H'l' further explai ned that·whathasbeendescribed inanu mber orexperimental andclinica.l

. . I · " .

reportsas'relaxation'may be simplya feelingofulmo!!ss•an"d have verylitt le to dowith theactualstat e oftens ionin tbemuscul atur e:(po160);.. a

Dll.ridson and Schwartz(1076)conclude tbatthere existsadistinclion between)pus("u la rand ·menta)·relaxation. AJthougb

~ne

^may

~ot-necessari1Y

l.i

dependuponthe other, tbeexperienceof relaxationwillli'kely bemoreflrn!l~unli whenbo thare present .

Giventhat eviden ceexistssugge5tlng thepresence of mode-s p ('{"itl(' manifestatio nsorenxletyindirte rent individuals Drinthesam eindividllnl~at .dirrer;nttimea.(e.g .Cor a~.g64;Eysenc k,1061) ,DavidsonandSrbwartzI U1711 1 proposethatrelax ationpr~~resdirrerin their errert,depe ndin guponthemode in.,'vhic banxie ty isexperieoce~ . Thetwo following'sections outline thrir

•" description ofseve ral

relaxatio~eedures,

^{andexa minethe}

~l'levnnt

^{rese archon}

di.Ucrentrelaxat iontechnique s,

I .Rela'xationprocedures.

,.

1.Progressi veRelax~tion(Ja cobson ,111381.involvell p~arilYthesom~ticsys tem, incorporatesactiv e and passive elements. andis probabl ythe most ex te nsively employe d relaxation technique today .The

errective~~

^{ofeven brief}training hasbeenwellesta b lished.This met hodor relaxat ion involves thesystema tic focusofatt en t ionon thevario usgross muscle groupsof thebod y.Theindivid ualisfirstinst ruct ed toact ivelyten~rCJ1('hmuaele grouplorafew second sandthentoreleasehismusclesand rela x.Theem p h as i~

on

progr~ive

^tel_a( at io n ison the

seU-gencrati~n.

^{ofso matic}

behav~lt

^and

l~(>

self-reg ulationo(aUen t io ntq somaticevents.Tensingeachmnjnrmuscleinfrf:l.~I·.~

thesa liency

or~tc

^cues,en ablingsu bjects topassively attend lo SI)('dfir'hUlly partswhilefaei~taliD gcompletesomaticrelaxat io n.

2.Hypn oti cSugg es tion isII.widelyusedrelaxationtechniqu el...g.IlarhN 'and Hahn.19 63;Paul. HI69).Thisprocedure Involv estheself'gellcralion01

ccgnit ive behe vicr,with passiv e atten t ion to somatic processespresentat

t hi

.. - ---

₁₆

lime.Severa lauthors (e.g.Shor,1950,1962;"Oeee.-1959) have su ggested thai hypnoticsuggestion usuallyinvolves analtE'ra lioDdI'e~gn iliveorient ation,which primarilyaHecls ashift in attentionfromthe_~xternalenvironmenttointernally generated cognitiveactivity. The active generation ofimagerywithoccasiona l nttemio ntosomatic prOCe-5Sl'S seemstobe animpo rta nt compo nentin the ('xecutionof a hypnotic~ugges l io n.

3, Autogl'nic Training wa.s.deve loped intheearly 1900's byJ.H.Schultz,II.

Berlinneuropsychiat rist.AIter surricienl pra ctice:.this techniqueinvolves passive somat icand cogniti ve atte ntion.Sitti ng in-anarmchairinaquietroom witheyes dosed,the

indti~al

^{isinstructedto}"passjvely concentrat("

o~

^the

.~cpetition' ~f

^I>

ver balrormulae .(e.g."myright arm iswarm-"Followi ngwarmthtraining ofall th~^limbs,concentrat ionfocusesoncardi~c^{activity usingthe}rOf~ula,"He~artbeat rnlmand·rpgular." Then therespiratory'mecha nismis introduc ed with "It breat hes me",followedby a warmthsuggestion intb.!.abdominal region ("My"- -'- ' solar.plexusis warm ").Finally, the formula ,"MyIorebead is cool" is introduced.

4.ZenMed,it atio~originatedin China hundreds ofyearsago.Onefor m of Zen Meditationisthemost bll5jcbreathingtechnique.Aprc duet of this formor medit ation is increasedIcelings or relaxation andcalmness(Maupin,1969). Zen

\: "

Medit ation,hasbee~classified as involving passive somatic~ttelltionalsell-

, .

regulation,

5. Tra nscende nta l Meditation(TM) is3simplecognit ive'techn ique entafiing tbe silent~epelitioDofa-mantra •

a

Sanskrit word orsound• to create a'

"concl.'otr'afed attit ude, "TM

involv~~'

^theself-generat ionora cognition'(n mantra) which even tua lly giveswaytopassive ,attenti0'!tto theman tra ·repenting

..

:- --

'17

itsel;,"TM b3.S been'described asinitil1l1r requiring both/lct ive nnd.passi\:1' cog ni'Qveco m pon ents. Individuals'Practicing TM typi~.l1y repnrt'itkrl'i\.~t'd feelings ofrelaxationand greatefemotionalsta bil.ity(W il.1Iact',1Q70).

6.Yap.eneompeseeemany diverse forms.Onevets 0:Ih,tl~li/;a, inco rpora tes twoproced ur es :[a] bodily postures,ornsanas . nd(hIhr....nth

-

,

cont rol,or prana yama.Both comp onentsofHathaYOg~involv nenvc!it' lf·

generation ofsomatic,behavior,.Practiring thistechnique'has been illlWIl to

...

increaserelaxation and roster positive mental health.

, , . !'

Davidson andSchwartz (11176) noll'the extremev~riabilitythatf'xisl~in methodologyand procedure ,makingmeaningfulc6m pllris'onsbetween r:laxntJon - ...

studies verydifficult .It becom esnecessary,therefore,toexamine some-recen t. studie s designedto ecmparedifferentrelexeuc ajecbnlq ues.

Stud iesrompllr ing rela xa.tion proced ur('S.Vari ousst ud ieshi'"Vl'eumpnred :progressive muscle.relaxation to other

t(.ia~atioJl

^{mst:ods'(e.g.}

";111, 1l)~;

^...

Bor geat ,1983;W?oUolk,Lehr er,McCa.nn:and 'Roon ey,1{l82;Lehr er,Woolrolk, ,Rooney,Mcca~,^'andCarringto n,1983;Heide~nci. Borkovl'("11183).F~r^l'xamPJl', I, hi,comp ar!

'Y O

01 the

'''fJ'''' ~r

dlrr",",

·"~;,,t;o,

techni ques,P,,,I110601 found that in general, both progressive relaxat ion training and hy pnot ic su ggestion produced

,i" in,

an "y" ... : etreets 'hOD ,

"U-"I"';,~; ·Ci ,"'G~r

~ procedur e.Howeve r,progressiv erelaxation trainingpro duce dsignificantlygreatcr

;eductionsthanhypn otic suggestioninsystemsnotunderdirectv~lu.n£aryeo~~rol [i.e.hurtrate,tonic muscletension)

Borgea.tIlQS3j comp ared progressive muscle relaxation to-sublimin',I.

#t '

18 rclu3.lion,ll.techniqu e using tlte relax ing,,,Hect

of

musicmixed withsubliminal relaxa t ion suggestions.'Theresear cherfound nosignifican tdifferencebetween tbe physlologfeal effects ofthe twotechniqu es. However, progress ive relaxa tion was .more ctteeuvein.reduemgtheEMC levelsofthe more anxious subjects (as'

measuredonthe IP AT Anxiety Scale,Catell andShe!r,lQa7). Results were -intcrp reted iniight

;r

^Denson's

tt1l'15f

hypoth esis that a generalandnatural ,.'* ·crl a xation response -~x is~swhich~anbefacilitatedbya dive rsityoftechniques.

Allhough b~thof these studiesround progressi ve-relaxat~ontobe more

, : ' I

(,rrt~('~ive,on seertainp~ysiologicalmeasures,.neithe ron~ ;w.eS5edthe subjects'

~~eof r('spondin.g'to anxiety priorto randomtr~atment^{as.nment.Thus,it is}

possibletha t difterentresults might havebeen'found ilsubjectsha been match ed 10lrc:'llnll'nt type. Itis interesting thatinb:sdiscussion.Paul(lQ6I describes progr essive relaxation nsbeingmo.~eerrecuve than hyp~otic,-sug9'stion in p,orl:"" rl"l"d·physiological ch...es.II, ,,,,ilml,h tbe thC':;''''strong

;~ cognitive responding may prim arily produce cognit ive (hllnges from a

·('ognit,ive· method . Testingthis assumptionwouldnecessiti,e_assessmentor mod!'orrespondingto anxieryandsubsequent matchingtoIItreatmentprocedure whid!focuses onthatsamemod e.

InHeide andBorkcvec'e (n I83)study,subjectsexperiencinggeue ra l tension were given onesessionoftraining ineach oftworelaxation mcth ods • progressive

.rclax atio'n

; nd

^mahtra meditation .

prl!-pos>A~catment

^{rating scalesand}

."! phy~iologj(,1l1

^measures

.g~:;~II;di~PI'"a~iO~S

^ducto treatment:wit h

t :

~lgnirit'nn lly grc_a,~~:~/det'reasernnnxiet~/physiologicl1lactiv ityin theprogressive relax at ion

-:~dition. Result~

also suggested ahigherIeel deneeor relexetlou-

- ." ~

ind ucedanxietywit bml'ditat iontha~wit hprogrl'Ssivtrelaxation.Ther~l'l\rrh...,~

explainedthisrindin&lIy tbeassumpt ion tbMIoeused("ognili\'l'a.lh'nti,,"i.~more

:1nXiet~ pro~okiDr;

^{and/ or 1t'SS}

ra("il~\ive-

^ofrf'l:uali onthan r,'('II!'....1 ....ma.liC'

':ttl entioo_

<, ( .

Progressiverela xationand mantr amt"dilah onW""l'al...mjla.rl"ilin th.' Lehrer et al.lIg83) st udy. An:r.:ioussubjects wererandomlya...."iltnrd In ..orHr these proced ures.craeoe trol group. RI'SUItSshowed Ihnt both tl't'hDi'IUl"I appeared to a':fleliora tea broad arrayorsymplom~. 1I0wt'\'!'r~l)ruP;lt'!i~ivl' relaxencngeJlerallyprcdueed amorepcwertulthempeuticdfl'rt.th a.1\IIIl,tlill\li"n.

Furthermore,limned supportwasprovidedforDavidson

. -

IUIlISrhw:lrll'slllli6)' hypoth esis r('gard i~g tbe specificit y or errerts of relaxntion r<)lIlpart't1In medi tatio n.

~

^{However ,}the only measuretoprovidethis suppo rt wasIorearm

~MC:

levels,whichwerelower lorprogressivetelaxa hoDIIll1Dror·mrd itatinn./lndIeIW.., formeditat iontban rcrthecontrolgroup.Paper aDtl,.eneil lUeasuu'SrC'\'t'al('(1 no dirferencl'Sincognitiveversus.somatic symptomsbet weenprogrl'!i~iY(,rd:n:ttiuo andmeditat ion. They «:iodudt'd that despiteIht'telal ivt' similarityofMlbjl"('l!!' responsesto thetwort'l3.xation procedures.itispossiblethat t('tlainprobl rm~

.may warr ant one teehnique over the other, and lor variou:Jdisorders, comhinations or teehniqueemay~roduct'^'more'powerf\ll Ull"rapl"utie err('("bthan

.~

eithermethod alone.

Despite thefi~dingsinbothortheI~ltetstlNirsthntptop;rr!lsiverelnxntiflo .\ ,_ wasmoreeffective thnnmedit~lion,^{severalecneernetometontipd. .'it!lt,itis} possiblethatdifrl"rentfindingsmight haveemergedir the suhtcrbw('ie matched totreatment s basedontheirindivid ualmode ofrl.'spondioKtoanxiety.AlthQIlKh

,

\.

20 /

!.t·hnfl'l nl (Hlli1) employe ddep endentmeasureswhitbtappedcognui eeand soma ticle vels ofarollu l.th(!!;('I.nxie'iyeom pooen ts ll.'l'renolincludedascrilt'ria rortreat m enlw igo ml'Dt.

Tofurt herelaboraterhisporm,It ISnotewort hy thtInastudy by\\dolton.:

et al,(lOS21. bot hp,ogr~ivt'·relu.atioD ud mediratjon wer t"found tobe f'f(('('tiveinamelioratingst resswithbothtreatment groupsmanifesting-significant improvem ent on a numberofdepe nde nt measuft'S••Moreover, on a daily quest ionnaire tomeasureco~nitiveandsomati~arousal,themedit at iongroup morefrequcntlyreportedlowered levels of cog? itivearousaland the progr,:ssive

.j-elaxntiongro\lpmorj frequentl yreportedloweredsomaticarousal,although

.these dirrerencu railed to reachstatisticalsignificance. Perh aps a more

distinctive patter noretreete might have therefore emerged betweenboth techniquesir.subjects badbeenassignedtotrea tmentsbasedon theirprima~y mode'orrt'5ponding to an:dety.

Anot her pointof concernistbe conclusiondrawnbyHeid e and Bcrkce ec (108.1)th3.t-Iceused cognitivt attention is

,

moreanxiety

.

provokingand/a.r less [:acilitativeorreluat iontbanrocu~edsomaticatt ent ion·(p.1811.This conclusion is opentg questionbeeeusenoaHempt wasmade toisolates~bjC('ls'mode or responding(cognit inversussomat ic)prior to treatmentassignment.Toillustrate tbi, poin t. when Norton. Rhodes,and Hauch(in press) considered the ..ch nra<·t er islksor.subjects experiencin grelaxationandrelaX4.lio~- ind ucedanxiety, relaxation-induced anxiety·was.round to~c.curonly'when amismatch occurred bet...eena person,',Iypicalexpressionoranxiety{i,e. cognitiveorsomaticVt nd .thelype ofrelaxationp~ocedure^{[l.e. mantrameditation versus progrMSive}

.. ^{I '}

:!I

relaxatron]

characterist ics in sludyingsubjects' responses10 fel.u ali<ln. mort ' slrikilll/;

di ff~ren{'es:JrE'found.Thefollowingthree stud iesinYI'stigatetlthis itlt·a .., Schwartz, DavidsonandGoiema n(Ig';"$\notedIhat Iln fortllnalel,..mllst

\ .

anxiety questionnai resprovide a single,globalscore rt'nl'rtinganunknown mixt u reofdiffeTI'D!formsofanxiety. Also,thl'Y pointed outthaidntnarr- cqrrcmUyava ila blethatindicat ethntdifrerC'ntrelaxati on procedures1,licitIlistind,

/ '

pattern sof autonomic aclivity""{e.g. Paul , HIGO). Hence,Srhwn rlzl' tIll.

conducted theirstudy with two goalsin mind:(a) todevelopananxiet ys}'mpIOlil check listwitbsepara te cognitive and 'somatic scales, and(blto assessthe('fricncy ofnsomatic procedurenod:I.cognitiveprocedur einthodiffl'Tential rodur-tion of the cognitiv eandsoma ticcomponentsofanxiety.

Individu alswhowerepracticing eitherml'ditatin~orphysic:!.1ex('r<'isrforat IC:lSt one monthwerethe subjectsofthis study. To assesstht'rirst go:!.1llf the study,all parti cipantscomplet eda'cognit ive-sornauc trailanxit·ty inventoryin the. contex t ofa lar ger battt'ry of~l'Sts. This Cognitive-Somatic Anxil'ty Qut'stionnairt'(CSAQ)WIl.Sconst ructed byselectingitoms _~~om'well-known

qu~stionnaircs^thaiwere indep endently alreed upon10f{'f1C'ctcugniti yeorsomatic

anxiety.'OnII.S·pointscale,subjectswere askedto-ratC' the degr('t' towhichyou I'jcneralll orlypicflllyexperience th issytp ptom whenY?I.Iare fceling anxi" us·. Sepa ra tecorrelationsbetweentnecognitiveandsoma tic_sl.'lI.l~of theCSAqand theTfI\ilform

o~e

SpielbergerState-l rait AnxietyInventory were both highly significant{r=0.67and0040,respectiv elyforboth,2

<

.00 11.Forthe en ti re

"sa mple,

~

^cognitiveand somaticscales ofthe CSAQ wer e modestlycorrelate d and theiisharedvariancewas sufficien tly low to allow for patt ernio g ofresul ts as afunctionof dirrerent "tr aioingtechniqu es(!.= 0.42).However ,Jurtberdata rl'gard ingreliabil ity and internal consiste ncyoftbe CSAQwerenotreportedin this study.

Regardingthesecondgoaloftbe study,resultsindicated tha tmeditators re portedlese cogniti veand more somat icanxietyth~Dexercisers , andconversely, that exercisersreported less somaticandmorecognitive anxiety thanmedit ators.-

~foroover,thetwo groups didnot,ditteronoverallanxietybutrathe ro~the specific patterningofanxiet ysubsyste ms. Thisisconsistentwiththehyp oth esis that the practiceofmeditation versus exercise~ayhe associate d,with the clirtl'rl.'nti al pat te rn ingofcognitive andsomaticsymptomsof anxie ty. The authors no)etha t thesefindings, alongwithothl.'l findingsin the lit erat ure, questionthenotionofageneralizedrelaxationresponse asacomplete description ofthenntur e of rela xation.Theysuggest thatdirr('ren ttecbniqut;l emp loyed to l.'li{'it relnxatlonmay beassociatedwithspecific~consequeDces,whichi~turnmaYI beafunctionoftheunderlying system sdirectlyaffected bytheprocedurein quest ion"

Consequently,Schwartz et al.(1978)proposedthatrelaxation consistsof:

a glDtralizedreduction iD mUlti plephyl1ologi cal .yatelll (t ermed the relaxati oDreapon..byBenlon)

&tid a mon IpeciUcpatttrDotchu g.. nplrimpo.ed upon the Sineral nducti on,whichfa elicitedby the particulartechll.1queImployed.The pr"'Dt liCtot ru,oDillS highlightsthl Impor t allceof conlll1dlr ing' the ..compoDu lt e in &ttycomple t l accountotatl:dety and itlreductioll .Cp.327) )

Lehrer, Schoieket,Cartington,andWoolfolk(19aO)testedanhypothesis

tb at training in meditationbasrdntivelygreater c!rcetson indicesuf('ognith '\' anxiety.whiletrai ning inprogressive rel axation hasgreat er effectson mensuresof somat ic arousal.Thirty-six volunte ersu bjectswereassignI'dto{'jlherprngre!l.~i \"\·

relaxation.clinicallystandardizedmeditation.or11wail ing list cont rol. Following four weeklysessionsofgroup.t raining(forthetreatmen tgrou~sonly),all~Ubjl'("t,.

were testedinamildl y stressfullabora torysession. Findings'ind i<':ltl'dt!l:\ttill' meditati on grou pexh ibited fewersymptomsofcognitiveanxiety thanthe IIthN twogrou ps,andt~e progressiverelax ~tiongro up rep orted-more sonsn tkmsof muscularrelaxationtha ntheother grou ps.Theseres~ltsare'consist t wit hlhfl~l' ofSch wartz etel.(19781and withtheDavidson-and Schwart z (10761hy thesi that meditat ion dirrerentially errects cognit ive sym ptomsof anxiet y while progress iverelexaticn diffcrl.'t1tia lly1.'£(1ctssoma t icsymptoms.

Finally,Nortonand Johnson (H1831studied the effectivenessoftwo diftl'rC'nt.

relaxa tion proceduresintreat ingsnakeanxiouspeoplewho expressed anxil'ty

in

priltJar ilyacognitive orprima rilya somaticmanner (as evaluated usingthe J

c,SAQ ,Schw artz, Davidson,and Oo teman, 1978f Half thesubjec tsin the cognit iveanxtetygro upand ball thesu bjectsinthesomaticanxiety group were randoml y, assigned~o^{eitherAgni Yoga}(hypoth esizedasbring moredfectivefor reduci ngcogn itiveanx iety)or progressiverelaxati on (hy pothesizedasbeing mor e effect ive for reducin gsomaticaDxiety ).resu lting in .Iour groups. Following trainin g sessions ofequal lengt h, measures weretakentoeVil ]. nnxlcty

1"C

snake.Thesemeasur esincluded appro ach distanc e,subj ect ivefr ar.pulse'rate,and a sna ke frar scale.

Theresul ts pa rt iallysu pported Davidso; SlidSchwartz's(1976) hypoth esis

r

2'·

',.Z,alC'o(l;oiljveandsoma lirally'anxioussubjectswouldbenef it morefro mdirrereol / ,, 'axa t ionproc edures.Itwas de:ulydemcnetrated tbatptogr~iverel ax ationwas moreetreetlveforred ucing somaticlI.Qxit'tythancognitiveanxiety.However.the ('rr(,(,~5of AgniYo~a⁰⁰('ogllitive.aaxittywe~eI~dear.Neeertbelesa. the researchersiri~('rpreted'tb~e^{liodiogs 85proyidiog} evidence thatsy nchron ous ehangee in beha viora l, physiologiul andsubjee tivedimensionsofanxietymightbe morelikelyto oeeurwhentheanxiety treatm en t procedure~m~tc:hed.to thetype orllox ietythe personisexp eriencing. Ulti ma tely,tbissuggeststbat tot:a.i1or a trea t menttoaniD~ivid ual'stypeofanxiety mayimprove genera ltreatm ent outcome wh ileproducing more synchrono us chan ges in l~ethr ee anxiety dimen sions.The presentstudyspeciCteally addreSsestbisproll:~m.

\

Approlll'hand hyOOlht'Sis.Theresearchreview provides sup po rtfor the interactio?alviewtb:ttat'onsiderat io nofbothtbepenon andthe situation is importantiDunderstandingand trea ti nganxiety. Thep~tstudywas designed torur t ht'r add ress thebypothesi!tba tpeoplewho experience cotnitive anxiety may bend ' tmore from a·cognitiye· relaxation proeedure,"wberees those who esperteneesomaticanxietymaybenefi t moreIroma procedurewhichfocusesOD

somatic anxi ety.Inetherwords,aperson's sllbjediveevalua t ion ofcognitiveand som aticanxiet ywill beerreeuveforpredict in g changesprodu cedbydiHeren t {i.e.

cognitive orsomatic ) relalat lonprocedures•.NortonandJoh nson(l gS3lprovide the bestpro tot)'ped", lgnforthepresent/researcb.There'arelive ways, hewev er..

in whichthe presentstudy dinersfro mthe st udies reportedintheliterature,and mote particlJlarlyfromthe NortonandJohnso n (1083) study:

v

j

1.In.ordertoadequatelystudy the t'r~t'rts^ofmode-spe cjficrl'laulin n methodsin anxietytreatment ,itisnecessarytoobtain1\."subjec tsamplewhich manifestsasurricieotly highlevelof anxiety.~1anyof thest~d i('spreviously cited h'a\'eemployeda c1inirAllyanxious[e.g. phob te] group. I!OWI' Hf,prohll'IIl Smny arise whenusing a clinical'group, suches thedirfkllltyi~ubtniu inll: tht·

appropr iat e Dumberand type ofsubjects. Also,lI.mo,nga,chnicnlly nnxious population ,anxi;ty is oflenconfounded withot herpsy chological eoneems , and it would thusbeco;nedifficult to distinguishthe_{varian~_.}attribut.ahle toanxiet y from the variance~Uributll.ble^toconfounding varfabloe.Forlunately,thecollege

•student population provides.nlargesampleofreadilyB.vnilableanxious,hut otherwise norm alindividuals,

Theuseofacollegestudent sam ple will allow forcomparisonsbetweenth(' reeuusof the present st udy and tbeNorton and Johnson(lQS31st udy.

It

^{will also}

facilitate bett ;,r'experi mentalcontrol, given t~at thelab situation ~i11 be consistent across }ubjects, Forexam ple, in the labsett ing, theerfectiv enl'S9of- treatmentisnot confounded withsuchth.in~a,.,length of practice,extraneous

distTl1cti~, ~tc.

^Finally, since anyone

~~n

potentially.-bencfithom relamtlon training , teaching relaxation skills to acollegesample isriolessvalunhle than teachingthesesame skillsto a·clinical· population.

': Nortonand Johnson

(l~~3J

^{d;,id,dtheirsubject}

;7'0

two

"~"P"

^{'hO':( "}

witha<cogniti ve mode andthosewitha somatic modebf expressinganxiety.

Giv ~n, ho~ever ,

^thetact that many

an ~ious

^{peopleexpressth';;;ll.n)ietyin'both a}

cogniti ve 31!d a somatii Iashlon,itwill beinteresfingto observewhl·the~.^either technique provesto be more erteetlvewhen applied to a groupwithmixed

,/

26

m:anirt'Sla lioDSofanxitty. Tbeadditionoratbird group may also indicate whether the twogrolJpSwithdjstine fivemodes ofa.Dxiety,cogni~i'e.and somatic, ereso~owdirrereont1ro ma"mixed"group intheirres~Dseto relaxation trai nin g

3.In the Nor tonandJobson(Igsa ) st udy.sll bj~tswereexposed toaseries 01rOlitrel a xationsessions.In the presco tstudy,th~'eUectsorsingle-session

rcl nxat jon trainingwillbe examined.Thiswillhavethe adyaotageorcontro lling

Jar 'subjects'motivat ionto pract leebetw een sessions. Foiethicalreasons, however,it.willbe emphas ised topar,ticip ants'tha lthey are~~otexpected to master theproce~urein a single,introductorysession..

.

.

Preyiou sresearch doessuggest, eeveetbetese,tbat asinglesessioncanbe erreetive. Forexample,Paul(1069)'Iouadtha tIcllowiag asingletrai ningsession,

.~~.h prog ressive relao tion and hypnot ic suggest ionprod uc~ red uct ionsin

,,su b~tivt'ly report ed leve)so~tea sice and di5trE'SSo, Moreover, progress.ive

•rt'!3u tionproduced significa ntlygreat erdecreasesin l'lperimenulsu bjectstha~

in controlsin~eartrate,museletension,andres piralor y~.ate, Paul-1~ 960 1\...:::'.

eoneleded that it iselear tbat hypnotic suggest ionand progressivemuscle rel am t joncanproducedecreased physiologi calarousal and,subject ivedistr ess. wit hin onetotwos('Ssio~s,

Other studieshavealsodemonstratedsignificant cha ngesfollo';in gone .~

relaxationsessiononsuch physiologicalmeasuresas heart rate,fespiuloryrnte,

..

sk inconduclllnc~,systolic'bloodpressure,endEM?,aswellasreductions in pre- post treatmentanxietyrlloti ngscal es(Scha ndlerandGriDg!I,1076;Heide and

. .

Borkcvee.1083;Norton,Rhodl'S,andHauch,in·press).

--...J

_I

)

finally,Borge,at(lg83jnotesthal:

In cl1 n1cal 11I1t.uat.l ona, 1II01llt. pat.1enu cOllie t.o ,

;;~~::~O~t~:; :~.::l~:~c:fl:;r::~::~-::~a::~r

1II0thaUond.pendson th.ir b,iUa l nperitnc.t

ThUB, tb. popularperc.pt.ionof at. chni que, it.,,hort -t'rmeubj.ct iY.eff.cta , it l phaunt and at.tracti,.. chat ac terit t i ceand1ta .itnpl1c1ty cons t i t ut . importantfacton -11k.l,. to affec t pathnts'.rp'c tt.DCl81andto influ.nc.their mothationtocont in u. with tb.t.c~nlque. (p.iSt) Perh apsit

w~

^beuseful, therefore,todetermi ne whetheronerejeration sessionis adequateto assessthe compatibilityQfa techniqueto the clientaswell11.'1,his motivationtoaJlply thl1ttech nique further.

,4.Intheir discussion,Norton andJohnson(IU83) suggest ed lhat'AgniYoga ispossibly notsoeffectivefor reducingecguitiveanxietyll!Iprogressiverelaxal ion

. .

isfor reducingsomat ic nnxiety.Theynote thl1t perhapsanother rd l!-.xal ioll ,/' procedurewithmoreconifive conte ntwou ldhaveproducedgreatl'frel:LXalio n .for the cognitively an. oussubjects..•uided imng';ryisarelnxation technique wh ich has been....usedwithsomesucces, and it may possib\have;'LrirhN ...

-

cognitivecomponentthan Agoi Yoga.

,Althoughsomestudies usedmantr ameditationastherDgnitive prm'l'Ih lrl' ,I' wit h wbichtocomp areprogressiverelaxation,manyorlh.l'(~studiesIalledlofind cognitive and somatic differences bet ween progressiverl'lf xati onand meditation (Woolfolk, Cerr-K erreshea, McNul,ty,and.Lehrer, IQ76;Zurofrn,dSehwar}, 1078 ;Lehreretal.,1983;Woolrolkctal.,10821.Moreover,some

(Jr

themha n' failedto demonstrate any superi orityof"medit auen training I)VI'r euntrol conditions (e.g. Goldman.Domito r,and Murray,\07g; Holmes.HltU;Smit h, 1075;Klindon,1083 ). Hen ce,it willbeinten·stin g·tc seeif mort-deuneuv«

28

differencesresultbetweenprogressiverelaxationandthe morehighlycogn it ive procedureof guided imagery.

Therationale fortheuse of guidedimage. . in treat inganxietyis suggested byKre geraod Feeler's{l(76)statementtbat any pleasant scene tbat can be constr ucted in themind 'seyewill producerelaxati on.Theyfurtherexplaintbat one producesrelaxatio.nbyimaginingoneself inarela xing situation.Themore vividt~eimage,the deepertherelaxa tion,and the soonertheeouq terco nditio ui ng can beaccom plished.It ispossible toconstruct a powerfulimage.ifODe

50ncentrat esand uses severalsensory modalities.A commonsceneem ploying all fivesensesispictvr ingoneselfwalking alo nga desertedbeach,-reeling- the

) I .

warmthof thesand,onone'sfeetandthe blfatofthesunon one 'sface,-smelling- and -lasting- thesalty air,-hear ing" the breezerustle th rough thetrees,

"m·ing" theblue oftheskyend W3tH, and thewhitenessofthesand.Itis important tofocus on'recalling these primarysensatio ns. With pract ice,the eelaxingseene can betutnedonandorr at will.

Eviden ce exists which illustra testhe.thetapeut icbenefitderi vedfrom, i.mngery[e.g.Lazarusand Abramovitz,Ig62;Horan ,'Ig73,Ig76;schand·~e.rand Dao 3,1083).Lazaru s and Abramovitz(lg621 employe dthe technique of zemcu ve imagery- with seve ralphobic children. 10"thisprocedur e, certa inemot ion- arou sing sit uatio ns arepresentedtothe child's imagination,and theemot ions induced are assumed tohaveauton omic effects whichareincompatible with anxiet y.The resl'ar chersfound that the majority ofthesech ildren recoveredina meanofonly3.3SCSSiOIlS,as demonstu.tedbytheircomfort in the presence of the phobi c stimuli and thereductionof phobie-relafed sym pto ms.

Schandler and Dana tlQS3) compared aseH· r(>~lcontro lpruCt'dllrt>to front alismusclefeedback relaxeticn and a guidedimagl'rypecroeot designedfOT gE'lIE'raltensionredu ction and control.ThE' imager ynarrllti vt>consistedorphrn.~es designedtoelicit.imagesassociat edwith r{'laxation.suchas: -Pkture)'oll rsI'UIII a warm.quiet seas hore ."Theseimageswert'Iurtber pairedwith tension-relntr-d images.

Results indicatedthatthe imageryproced ureW3...<;associat edwithmodornte reductlcns in physiologicaltension andsigniricant reduct ionsinsta ll'anxietyand' threetension-relatedpersonality dimensions.Onthe otherhand,tho bioft't·tlba('k group sho wed thelargestreduct ions'inphyslologlcal tension,withonly~mll.lI changesinstateanxiety and personalitydimensions. Littlechangewasproduced by thesE'.I' · restcon trol procedure.Thert!sE'~rchersconcludedthatthl's!'rN;uils supportthe use orcognit ivelymediatedprotocolsill the treatmentofspl'rifie ur generalanxietybehavior s.

In,a single-sessionapproach,it islikely tbat su bjects wiltachievomore pronoull(',:d benefitstromthecognitively richerproced ureor,guidedirnaF;rrythllt rrcm mantrameditation. In looking at studieswhichexaminedOw (.tri'rti'H'nl'Ss\

. . i

ofmantra meditation,benefits...eremoreappar ent inpl'opleprnctieing thl' techniqueoveralong period(e.g"Smith,H175;Schwartz(·tal.,11)7~ '.Itis possiblethat this mayalso be tbli.casewith'yoga.Moreover .gllid" dimageryisa.- procedure easily administered by most therapis tswithoutthe intensive prior trainingthatyoga and('crtainothermethodsmight entail: and there fore,mon- suited to usein a single-sessiontrea tment.

5.Norto nand Johnson(lgS3)not e that,withtheexceptinn -of theSnake

'.

^.\